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Transfusion Dec 2022Transfusion-related acute lung injury (TRALI) is a severe complication of blood transfusion that is thought of as a two-hit event: first the underlying patient condition... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Transfusion-related acute lung injury (TRALI) is a severe complication of blood transfusion that is thought of as a two-hit event: first the underlying patient condition (e.g., sepsis), and then the transfusion. Transfusion factors include human leukocyte antigen antibodies or biologic response modifiers (BRMs) accumulating during storage. Preclinical studies show an increased TRALI risk with longer stored platelets, clinical studies are conflicting. We aim to discover whether longer platelet concentrate (PC) storage time increases TRALI risk in a controlled human experiment.
STUDY DESIGN AND METHODS
In a randomized controlled trial, 18 healthy male volunteers received a first hit of experimental endotoxemia (2 ng/kg lipopolysaccharide), and a second hit of fresh (2-day old) or aged (7-day old) autologous PC, or physiological saline. After 6 h, changes in TRALI pathways were determined using spirometry, chest X-ray, and bronchoalveolar lavage (BAL).
RESULTS
All subjects reacted adequately to lipopolysaccharide infusion and satisfied SIRS criteria (increased pulse [>90/min] and temperature [>38°C]). There were no differences between the saline, fresh, and aged PC groups in BAL-fluid protein (95 ± 33 μg/ml; 83 ± 21 μg/ml and 104 ± 29 μg/ml, respectively) and relative neutrophil count (1.5 ± 0.5%; 1.9 ± 0.8% and 1.3 ± 0.8%, respectively), nor in inflammatory BAL-fluid BRMs (Interleukin-6, CXCL8, TNFα and myeloperoxidase), clinical respiratory parameters, and spirometry results. All chest X-rays were normal.
CONCLUSIONS
In a human endotoxemia model of autologous platelet transfusion, with an adequate first hit and platelet storage lesion, transfusion of 7-day-old PC does not increase pulmonary inflammation compared with 2-day-old PC.
Topics: Male; Humans; Platelet Transfusion; Transfusion-Related Acute Lung Injury
PubMed: 36300793
DOI: 10.1111/trf.17157 -
Transfusion Apr 2021
Topics: Adult; Altruism; Blood Donors; Blood Platelets; Fees and Charges; Humans; Middle Aged; Motivation; Platelet Transfusion; Red Cross
PubMed: 33831224
DOI: 10.1111/trf.16329 -
Platelets Jan 2022Bacterial contamination of blood components is a recurrent topic in transfusion medicine community. This issue is even more important with platelet transfusions because...
Bacterial contamination of blood components is a recurrent topic in transfusion medicine community. This issue is even more important with platelet transfusions because of storage of platelet components at room temperature for 5 days. Pathogen inactivation methods are a proactive approach to deal with an infectious agent. All available methods use UV light, with or without a photosensitizer, to inactivate potential pathogens. As with other medical interventions, pathogen inactivation methods carry benefits and risks. Among benefits, inactivation of known and unknown transfusion-transmitted pathogens, inactivation of residual leukocytes, and increased storage length from 5 to 7 days are the most interesting. The main risk is the impact on clinical efficacy of pathogen-reduced platelets. After inactivation, pathogen-reduced platelets are associated with a lower number of platelets in the final product, lower 24-hour corrected count increment, and shorter transfusion interval when compared with non-inactivated platelets. However, eight of nine randomized controlled trials showed that transfusing pathogen-reduced platelets were not inferior to transfusing usual platelet components in the prevention of bleeding episodes. In conclusion, in our opinion, increasing safety of platelet transfusions with pathogen inactivation methods is worthy, even the trade-off of causing damage to platelets.
Topics: Blood Platelets; Humans; Platelet Transfusion
PubMed: 34092184
DOI: 10.1080/09537104.2021.1935838 -
JPMA. the Journal of the Pakistan... Dec 2017
Topics: Adult; Dengue; Humans; Platelet Transfusion; Purpura; Thrombocytopenia
PubMed: 29256559
DOI: No ID Found -
Transfusion Medicine Reviews Oct 1998
Review
Topics: Blood Platelets; Humans; Platelet Activation; Platelet Function Tests; Platelet Transfusion
PubMed: 9798270
DOI: 10.1016/s0887-7963(98)80003-5 -
Seminars in Hematology Apr 2000For the past 30 years, platelet transfusions have been used in the treatment of thrombocytopenia caused by decreased production, inadequate function, or increased... (Review)
Review
For the past 30 years, platelet transfusions have been used in the treatment of thrombocytopenia caused by decreased production, inadequate function, or increased destruction of platelets. The number of platelet transfusions has increased more than transfusions of other blood components, shifting from whole blood use for the platelet source to plateletpheresis. Hematology/oncology patients are among the largest group receiving platelet transfusions, primarily because the more aggressive chemotherapies produce more acute and prolonged thrombocytopenia. While platelet transfusions often rescue patients with very low platelet levels, they are associated with the risk of viral and bacterial infections, as well as alloimmunization. Platelet donor recruitment can also be difficult, and platelet transfusion can be very expensive depending on the source of platelets. As a result, prophylactic transfusions are less likely to be administered at higher platelet counts, reducing platelet use and cost of platelet transfusions. However, cancer patients receiving intensive chemotherapy or myeloablative regimens require multiple platelet transfusions. For these patients, alternate strategies are needed so that platelet transfusions can be significantly reduced or eliminated.
Topics: Antineoplastic Combined Chemotherapy Protocols; Disease Transmission, Infectious; Hemorrhage; Humans; Neoplasms; Platelet Transfusion; Thrombocytopenia
PubMed: 10831283
DOI: 10.1016/s0037-1963(00)90047-7 -
Transfusion and Apheresis Science :... Jun 2021The measurement of corrected count increment at 1-h post-transfusion (CCI-1 h) of platelet concentrate (PC) transfusion is recommended, but in the revised Japanese...
The measurement of corrected count increment at 1-h post-transfusion (CCI-1 h) of platelet concentrate (PC) transfusion is recommended, but in the revised Japanese Guideline (2017) it was changed to "after 10-min to 1-h", following the revision of the guidelines from Western countries. Here, we aimed to investigate on the feasibility to apply the CCI measured at 10-min or 30-min post-transfusion as the surrogate of CCI-1 h. Peripheral blood was collected at 10-min, 30-min and 1-h post-transfusion of PC and the effectiveness of the transfusion was analyzed based on the CCI. In the period from December 2017 to February 2020, 8 patients, who received multiple PC transfusion (total 208) at our institution, were analyzed. We performed the univariate analyses to examine the relationship between CCI value and the categorical variables, p-value <0.1 was obtained for gender (p = 2.91 × 10), fever after transfusion (p = 0.0163). The qualitative variables, namely measurement time (p = 0.0553), also showed p-value <0.1. Using these factors as covariates in the mixed effect model, we found that the measurement time (p = 0.0007) had a significant effect on the CCI value when looking at fixed effects. Although there is a tendency for decreased CCI values with time progression, the slope of the change in the mixed model was -0.00307, indicating that the CCI difference among the 3 measurements was small. Here we provide evidence that CCI measured at 10-min and 30-min post-transfusion give results comparable to those measured at 1-h post-transfusion, under the Japanese practice of platelet transfusion, which relies on 100 % single-donor apheresis PC, and ABO-identical whenever possible.
Topics: Aged; Aged, 80 and over; Blood Preservation; Female; Humans; Male; Platelet Transfusion; Time Factors
PubMed: 33757699
DOI: 10.1016/j.transci.2021.103123 -
Seminars in Hematology Oct 2001Methods of collection, preparation, and transfusion of platelet components have evolved markedly since the introduction of modern platelet transfusion therapy three... (Review)
Review
Methods of collection, preparation, and transfusion of platelet components have evolved markedly since the introduction of modern platelet transfusion therapy three decades ago. Despite these improvements, few randomized, prospective, controlled studies have been conducted to evaluate the effects of these innovations on the outcome of platelet transfusion--prevention and treatment of bleeding due to thrombocytopenia. The majority of studies have used posttransfusion platelet count increments (CIs) as the primary outcome variable rather than bleeding assessments. In general, these studies have only examined average values for platelet CIs or adjusted ratio measures such as corrected count increment (CCI). Because platelet transfusions are given repeatedly over variable periods of time, this type of analysis has not provided information about the effects of multiple platelet transfusions or about specific product or patient-related covariates that may impact the outcome. Longitudinal regression analysis of platelet CIs offers the potential to provide more information than simple average values of ratio measures. The euroSPRITE trial, a European, multicenter, phase III study undertaken to assess the clinical efficacy and safety of platelets prepared with Helinx technology (Cerus Corp, Concord, CA), used longitudinal regression analysis to characterize more fully the response to platelet transfusions with products prepared with this new pathogen inactivation technology. In contrast to previous studies, the euroSPRITE study examined peritransfusion hemostasis and global indices of hemostasis to correlate the effect of platelet CI with prevention and treatment of bleeding during a period of platelet transfusion support.
Topics: Blood Platelets; Clinical Protocols; Furocoumarins; Humans; Photochemotherapy; Photosensitizing Agents; Platelet Transfusion
PubMed: 11727285
DOI: 10.1016/s0037-1963(01)90123-4 -
Clinics in Perinatology Sep 2015There is significant world-wide variability in platelet transfusion thresholds used to transfuse thrombocytopenic neonates. A large multicenter randomized controlled... (Review)
Review
There is significant world-wide variability in platelet transfusion thresholds used to transfuse thrombocytopenic neonates. A large multicenter randomized controlled trial comparing 2 different platelet transfusion thresholds in neonates is currently ongoing, and should provide data to guide transfusion practice. However, several studies have found that factors other than the degree of thrombocytopenia determine the bleeding risk. Thus, it will be important to develop better tests to assess primary hemostasis and bleeding risk in neonates.
Topics: Humans; Infant, Newborn; Intensive Care Units, Neonatal; Platelet Transfusion; Thrombocytopenia
PubMed: 26250921
DOI: 10.1016/j.clp.2015.04.009 -
Academic Emergency Medicine : Official... Jun 2023Reported risk of bleeding complications after central catheter access in patients with thrombocytopenia is highly variable. Current guidelines recommend routine...
BACKGROUND
Reported risk of bleeding complications after central catheter access in patients with thrombocytopenia is highly variable. Current guidelines recommend routine prophylactic platelet (PLT) transfusion before central venous catheter placement in patients with severe thrombocytopenia. Nevertheless, the strength of such recommendations is weak and supported by observational studies including few patients with very low PLT counts (<20 × 10 /L). This study aims to assess the risk of bleeding complications related to using or not using prophylactic PLT transfusion before ultrasound-guided central venous access in patients with very low PLT counts.
METHODS
This was a retrospective cohort study of patients with very low PLT counts (<20 × 10 /L) subjected to ultrasound-guided central venous catheterization between January 2011 and November 2019 in a university hospital. Bleeding complications were graded according to the Common Terminology Criteria for Adverse Events. A multivariate logistic regression was conducted to assess the risk of major and minor bleeding complications comparing patients who did or did not receive prophylactic PLT transfusion for the procedure. Multiple imputation by chained equations was used to handle missing data. A two-tailed p < 0.05 was considered statistically significant.
RESULTS
Among 221 patients with very low PLT counts, 72 received prophylactic PLT transfusions while 149 did not. Baseline characteristics were similar between transfused and nontransfused patients. No major bleeding events were identified, while minor bleeding events were recognized in 35.7% of patients. Multivariate logistic regression analysis showed no significant differences in bleeding complications between patients who received prophylactic PLT transfusions and those who did not (odds ratio 0.83, 95% confidence interval 0.45-1.55, p = 0.567). Additional complete case and sensitivity analyses yielded results similar to those of the main analysis.
CONCLUSIONS
In this single-center retrospective cohort study of ultrasound-guided central venous access in patients with very low PLT counts, no major bleeding was identified, and prophylactic PLT transfusions did not significantly decrease minor bleeding events.
Topics: Humans; Retrospective Studies; Platelet Transfusion; Hemorrhage; Thrombocytopenia; Ultrasonography, Interventional
PubMed: 36587310
DOI: 10.1111/acem.14651